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General NPI Number Information
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NPI Number | 1316759327
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Entity Type | Organization
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Legal Business Name | CELEBRATION PEDIATRIC DENTISTRY, PA
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 1530 CELEBRATION BLVD STE 411
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City | CELEBRATION
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State | FL
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Zip | 34747-5165
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Country | US
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Telephone | 407-247-8219
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Fax | 407-566-4647
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Provider Business Mailing Address
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Address Line | 1530 CELEBRATION BLVD STE 411
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City | CELEBRATION
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State | FL
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Zip | 34747-5165
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Country | US
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Telephone | 407-247-8219
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN GOOCH
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Credential |
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Telephone | 407-247-8219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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